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Vers un modèle national de télésurveillance en insuffisance cardiaque : proposition d'un cadre organisationnel à partir d'un consensus infirmier ville-hôpital 建立全国心脏衰竭监测模式:基于医患共识的组织框架建议
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101929
Christine Lecerf , Gauthier Lefranc , Nathalie Vionnet , Valérie Ple , Emilie Saunier , Céline Picard , Céline Chauveau , Nawel Aouni
Remote monitoring of heart failure is now being deployed throughout France. It allows for effective remote monitoring and aims to improve patients' quality of life. Given the heterogeneity of practices, a committee of nurses has proposed a structured and reproducible organizational framework based on four pillars: Engage, Personalize, Support, and Coordinate.
This model encourages the standardization of practices, improves patient adherence, and ensures quality follow-up. Remote monitoring must remain temporary, educational, and patient-centered. Indicators must be used to assess its effectiveness.
心力衰竭的远程监测目前正在法国各地部署。它允许有效的远程监控,旨在提高患者的生活质量。鉴于实践的异质性,一个护士委员会提出了一个基于四个支柱的结构化和可复制的组织框架:参与、个性化、支持和协调。这种模式鼓励实践的标准化,提高患者的依从性,并确保高质量的随访。远程监测必须保持临时性、教育性和以患者为中心。必须使用指标来评估其有效性。
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引用次数: 0
Optimization of Post-ACS Management in France: National Consensus Outcomes from the EuroPath II Initiative 法国acs后管理的优化:来自EuroPath II倡议的全国共识结果
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-10-23 DOI: 10.1016/j.ancard.2025.101969
Marc Villaceque , Cyrille Bergerot , François Schiele , Pierre Sabouret , Chaimae Ighidi , Franck Boccara , Jean Ferrières , Meyer Elbaz , Adrien Lemaitre
<div><h3>Background</h3><div>The in-hospital management of acute coronary syndrome (ACS) is clearly established; however, post discharge, ACS patients face significant challenges including securing timely follow-up appointments, managing complex medication regimens, and maintaining long-term adherence to lifestyle changes while lacking adequate psychological support. A national Delphi consensus process was conducted to assess post-ACS management practices in France. This involved administration of a structured questionnaire to a panel of experts, aiming to evaluate current clinical practices and establish a unified approach.</div></div><div><h3>Methods</h3><div>The outcomes of the national consensus on post-ACS management were developed with the collective clinical expertise and real-world experience of a panel of French cardiologists. A two-day national face-to-face expert board was convened to identify challenges in post-ACS management and collaboratively develop solutions aimed at harmonizing clinical practices across France. Building upon the insights gathered during this board, a structured national survey was subsequently distributed to assess and further standardize these practices nationwide.</div></div><div><h3>Results</h3><div>A comprehensive post-ACS checklist proposes a structured pathway integrating hospital discharge protocols, scheduled follow-up appointments, secondary prevention treatments, rehabilitation planning, and a standardized discharge document for transmitting comprehensive patient information to ensure safe discharge from hospital. The European Society of Cardiology (ESC) guidelines for post-ACS care pathway management include in-hospital empowerment consultation by cardiologists and specialized nurses, scheduled appointments (4–6 weeks and 1-year with a cardiologist), intermediate follow-ups through calls or visits, cardiac rehabilitation planning, and coordinated communication among healthcare providers (utilizing digital tools and trained networks) to maintain consistent prevention messaging and enhance patient adherence. To warrant 100% review of post-ACS patients within 6 weeks post discharge, coordinated discharge planning, mandatory training for healthcare correspondents, streamlined appointment scheduling, patient education, and media engagement to facilitate effective follow-up care are necessary. The first post-ACS consultation encompasses a comprehensive approach, including disease history review, risk factor assessment, determination of the extent of coronary disease via angiography, clinical and laboratory evaluations, treatment optimization, lifestyle counseling, patient education on warning signs, psychosocial support, cardiac rehabilitation options, and follow-up planning, aimed at reducing recurrence risk and ensuring optimal patient care. The ESC guidelines-based personalized approach for medication management between 1 and 12 months includes antiplatelet treatment (intensity modulated by selecting a p
背景:急性冠脉综合征(ACS)的院内管理是明确的;然而,出院后,ACS患者面临着重大挑战,包括确保及时随访预约,管理复杂的药物治疗方案,以及在缺乏足够心理支持的情况下保持长期坚持生活方式的改变。在法国进行了全国德尔菲共识过程,以评估acs后的管理实践。这涉及到向专家小组提供结构化问卷的管理,旨在评估当前的临床实践并建立统一的方法。方法:全国共识的acs后管理结果是由一组法国心脏病专家的集体临床专业知识和实际经验制定的。召开了为期两天的全国面对面专家委员会会议,以确定acs后管理的挑战,并共同制定旨在协调法国临床实践的解决方案。在此期间收集的见解的基础上,随后分发了一份结构化的全国调查,以评估和进一步规范全国范围内的这些做法。结果acs后综合检查表提供了一种整合出院方案、定期随访预约、二级预防治疗、康复计划和标准化出院文件的结构化路径,以传递全面的患者信息,确保出院安全。欧洲心脏病学会(ESC) acs后护理路径管理指南包括由心脏病专家和专业护士进行院内授权咨询,定期预约(与心脏病专家进行4-6周和1年的预约),通过电话或访问进行中期随访,心脏康复计划,医疗保健提供者之间的协调通信(利用数字工具和经过培训的网络),以保持一致的预防信息并提高患者的依从性。为了保证在出院后6周内对acs患者进行100%的复查,必须协调出院计划,对医疗保健通讯员进行强制性培训,简化预约安排,患者教育和媒体参与,以促进有效的随访护理。acs后的第一次咨询包括全面的方法,包括病史回顾、风险因素评估、通过血管造影确定冠状动脉疾病的程度、临床和实验室评估、治疗优化、生活方式咨询、患者警告信号教育、社会心理支持、心脏康复选择和随访计划,旨在降低复发风险并确保最佳患者护理。根据基线和随访低密度脂蛋白(LDL-C)水平,基于ESC指南的1 - 12个月药物管理个性化方法包括抗血小板治疗(通过选择有效的p2y12受体抑制剂调节强度)、β受体阻滞剂、血管紧张素转换酶抑制剂和降脂治疗(包括他汀类药物、依折替米贝和蛋白转化酶枯草菌素/ keexin 9型抑制剂[PCSK9i])。在住院期间,依zetimibe被推荐作为已经接受最高耐受性他汀类药物(ldl - 1.4 mmol/L (55mg/dL))的患者的附加治疗。如果在给予最大耐受治疗(他汀+依泽替米贝)后LDL-C仍≥70 mg/dL,则应考虑PCSK9i。对于ACS合并糖尿病的患者,对于超重的冠状动脉患者,无论是否患有糖尿病,考虑使用胰高血糖素样肽-1受体激动剂(GLP1-AR)和钠-葡萄糖共转运蛋白2抑制剂治疗,以减少心血管事件的发生率。结论acs后检查表旨在构建≥3个时间点(出院、4-6周和12个月)的患者路径,以标准化acs后预防的整体和基于指南的个性化方法。
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引用次数: 0
Efficacy and Safety of SGLT2 Inhibitors in Heart Failure: Observational Evidence in Geriatric Patients AGING-HF SGLT2抑制剂治疗心衰的疗效和安全性:老年心衰患者的观察证据
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-10-23 DOI: 10.1016/j.ancard.2025.101961
A. Hacil MD , Y. Antakly-Hanon MD , A. Lacour MD , J.P. David MD, PhD , T. Khalifa MD , M. Piccoli MD , A. clemencin MD , P. Assayag MD, PhD , J.S. Vidal MD, PhD , O. Hanon MD, PhD

Contexte

Les inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT2) ont montré des effets bénéfiques dans la prise en charge de l'insuffisance cardiaque (IC), mais les données concernant leur utilisation chez les populations gériatriques à forte comorbidité restent limitées. Cette étude observationnelle avait pour but d’évaluer l’efficacité et la tolérance des iSGLT2 en conditions réelles chez des patients âgés atteints d’IC.

Méthodes

Cette étude prospective multicentrique a inclus 496 patients hospitalisés pour insuffisance cardiaque aiguë (ICA) dans trois unités gériatriques. L'âge moyen était de 90 ans, avec un score moyen de comorbidité de Charlson de 8,2. Les participants ont été répartis en deux groupes: le groupe iSGLT2 (n=260), recevant de l’empagliflozine ou de la dapagliflozine en complément du traitement standard de l’IC, et le groupe contrôle (n=236), recevant uniquement le traitement standard. Les critères de jugement principaux étaient la mortalité toutes causes confondues, les réhospitalisations pour IC, et les événements indésirables sur un an.

Résultats

L’utilisation des iSGLT2 était associée à une réduction du risque de mortalité toutes causes confondues (HR 0,67 [IC 95%: 0,46–0,98], p = 0,031), de réhospitalisation pour IC (HR 0,64 [IC 95%: 0,42–0,97], p = 0,037), et du critère combiné (HR 0,60 [IC 95%: 0,44–0,82], p = 0,001) à un an, après ajustement multivarié. Aucune interaction significative n’a été observée entre la fraction d'éjection du ventricule gauche et l'utilisation des iSGLT2 (p pour interaction = 0,12). Bien que les infections urinaires et génitales aient été rapportées plus fréquemment dans le groupe iSGLT2, le taux d’arrêt du traitement est resté faible (2,7%).

Conclusion

Chez cette population très âgée et à forte comorbidité, le traitement par iSGLT2 était associé à une réduction significative de la mortalité et des réhospitalisations pour IC, avec une bonne tolérance et un profil de sécurité acceptable.
2型葡萄糖钠共转运体抑制剂(iSGLT2)已显示出治疗心力衰竭(ICD)的有益作用,但其在高共病老年人群中的应用数据仍然有限。这项观察性研究的目的是评估iSGLT2在实际条件下对老年IC患者的疗效和耐受性。这项前瞻性的多中心研究包括496名在三个老年病房住院的急性心力衰竭(AICs)患者。平均年龄为90岁,查尔森共病评分为8.2。参与者被分为两组:iSGLT2组(n=260)接受empagliflozin或dapagliflozin作为标准CI治疗的补充,对照组(n=236)只接受标准CI治疗。主要的判断标准是所有原因的综合死亡率、IC的再住院和一年内的不良事件。RésultatsL’utilisation iSGLT2是相关联的所有原因死亡率将降低风险(HR 0.67 [95% ci: 0.46—0.98],p = 0.031 HR réhospitalisation为IC (0.64), [95% ci: 0.42—0.97],p = 0.37)和组合标准(HR 0.60 [95% ci: 0.44—0.82],p = 0.001),一年之后,调整来。左心室喷射部分与iSGLT2的使用之间没有显著的相互作用(p为相互作用= 0.12)。虽然尿路感染和生殖器感染在iSGLT2组中更常见,但治疗停止率仍然很低(2.7%)。结论在这一高度老年和高共病人群中,iSGLT2治疗与显著降低IC死亡率和再入院相关,具有良好的耐受性和可接受的安全特征。
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引用次数: 0
Sommaire 摘要
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-10-23 DOI: 10.1016/S0003-3928(25)00113-1
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引用次数: 0
Évaluation du strain de l’oreillette gauche en échocardiographie : intérêt physiopathologique, diagnostique et pronostic 超声心动图左心绞痛评估:生理病理意义、诊断和预后
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101934
Patrick Meimoun, Karina Rahmouni, Ines Idir, Vanessa Kacy, Houssam Louhani, Jérome Clerc
Several studies have evaluated left atrial function, mainly using two-dimensional longitudinal myocardial strain with the speckle tracking technique. The study of left atrial strain (LAS) allows the analysis of the different phases of left atrial function (reservoir, conduit, pump) and its correlations with left ventricular systolic and diastolic function, and exercise capacity. Furthermore, LAS has diagnostic value in estimating left ventricular diastolic dysfunction and filling pressure. It helps differentiate the etiologies of left ventricular hypertrophy and has prognostic value in various diseases, including heart failure, valvular diseases, coronary artery disease, atrial fibrillation, and various causes of left ventricular hypertrophy. In this review, we will focus on these topics and discuss the growing interest in three-dimensional LAS.
一些研究评估了左心房功能,主要是利用二维纵向心肌应变与斑点跟踪技术。左心房应变(LAS)的研究可以分析左心房功能(贮、管、泵)的不同阶段及其与左心室收缩、舒张功能和运动能力的相关性。此外,LAS在估计左室舒张功能障碍和充盈压力方面具有诊断价值。它有助于区分左心室肥厚的病因,并对各种疾病有预后价值,包括心力衰竭、瓣膜疾病、冠状动脉疾病、心房颤动和各种原因的左心室肥厚。在这篇综述中,我们将重点讨论这些主题,并讨论对三维LAS日益增长的兴趣。
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引用次数: 0
Implantation de stimulateurs cardiaques sans sonde : plaidoyer pour un élargissement des conditions d’implantation dans les centres sans chirurgie cardiaque 无导管心脏起搏器的植入:呼吁扩大无心脏手术中心的植入条件
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101941
Walid Amara , Anas El Mahi , Ahmed Salhi , Pierre Socié , Cyrus Moini , Jérôme Taieb
Leadless pacemakers’ implantations in France are limited to centers with onsite cardiac surgery. However, these implantations are now possible in centers without onsite surgery in most European countries. Indeed, the rates of tamponade and cardiac perforation are very low. This article argues for the implantation conditions to be extended to centers with thoracic or vascular surgery (and not cardiac), as is the case for atrial fibrillation ablations, because these centers already have immediate surgical back-up, allowing the treatment of cardiac tamponade or perforation.
在法国,无铅心脏起搏器的植入仅限于有现场心脏手术的中心。然而,在大多数欧洲国家,这些植入物现在可以在中心进行,而无需现场手术。事实上,心包填塞和心脏穿孔的发生率非常低。本文主张将植入条件扩展到胸外科或血管手术中心(而不是心脏),就像心房纤颤消融的情况一样,因为这些中心已经有立即的手术支持,可以治疗心脏填塞或穿孔。
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引用次数: 0
DOME-HF : évaluation rétrospective sur six mois de la prise en charge diurétique ambulatoire chez des patients âgés atteints d’insuffisance cardiaque DOME-HF:对老年心力衰竭患者门诊利尿剂管理的6个月回顾性评估
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-09-22 DOI: 10.1016/j.ancard.2025.101933
Marlène Esteban , Olivier Maurou , Marc Harboun , Sophie Nisse Durgeat , Rémi Esser

Introduction

Heart failure (HF) is a major cause of morbidity and mortality in older adults, with a rising prevalence after the age of 70. Conventional hospitalization, commonly required in this frail population, exposes patients to numerous iatrogenic complications. Alternative care models, such as diuretic-based day hospital (DH) management, may help mitigate these risks.

Objectives

To describe the geriatric profile of patients treated for acute heart failure (AHF) in a diuretic day hospital within a cardiogeriatrics unit, and to report the organization of the associated care pathway.

Methods

This was a retrospective, observational, monocentric study conducted in the cardiogeriatrics department of Hôpital La Porte Verte (Versailles, France). Patients aged ≥65 years who were treated in a diuretic day hospital for acute heart failure between January and June 2025 were included. Geriatric, cardiologic, and organizational data were collected from medical records. A purely descriptive analysis was performed.

Results

Forty patients were included, with a mean age of 88 ± 6.8 years. Most lived at home (95%) and had preserved autonomy (mean ADL score: 5.4). The average Charlson Comorbidity Index was 8.9 ± 2.3; 50% were at risk of malnutrition and 92.5% had chronic kidney disease. From a cardiologic standpoint, 57.5% had preserved LVEF and 67.5% had atrial fibrillation. The mean delay between referral and the first day hospital session was 1.6 days, with an average of 3.1 sessions per patient. The rate of subsequent full hospitalization was 12.5%. Main complications included electrolyte disorders (5%), non-catheter-related infections (7.5%), and acute kidney injury (7.5%). Following day hospital management, 22.5% of patients were enrolled in a geriatric frailty day hospital program, 32.5% in an intravenous iron day hospital, and 22.5% in a remote monitoring program.

Conclusion

This diuretic day hospital model, integrated into a structured geriatric care pathway, appears feasible, safe, and relevant for managing very elderly patients with acute heart failure. It may represent an effective alternative to conventional hospitalization.
心衰(HF)是老年人发病和死亡的主要原因,70岁以后患病率上升。传统的住院治疗,通常需要在这个虚弱的人群,使患者暴露于许多医源性并发症。替代护理模式,如以利尿剂为基础的日间医院(DH)管理,可能有助于减轻这些风险。目的描述急性心力衰竭(AHF)患者在一家利尿日间医院的老年内科治疗的老年特征,并报告相关护理途径的组织。方法:这是一项回顾性、观察性、单中心研究,在Hôpital La Porte Verte (Versailles, France)心脏科进行。纳入2025年1月至6月期间在利尿日间医院治疗急性心力衰竭的年龄≥65岁的患者。从医疗记录中收集老年、心脏病和组织数据。进行了纯描述性分析。结果入选患者40例,平均年龄88±6.8岁。大多数人(95%)住在家里,并保持了自主性(平均ADL评分:5.4)。平均Charlson合并症指数为8.9±2.3;50%的人有营养不良的危险,92.5%的人患有慢性肾病。从心脏病学的角度来看,57.5%的患者保留了LVEF, 67.5%的患者有心房颤动。从转诊到第一天住院之间的平均延迟为1.6天,平均每位患者为3.1次。随后完全住院率为12.5%。主要并发症包括电解质紊乱(5%)、非导管相关感染(7.5%)和急性肾损伤(7.5%)。在日间医院管理之后,22.5%的患者入组了老年虚弱日间医院项目,32.5%入组了静脉注射铁日间医院项目,22.5%入组了远程监测项目。结论:将这种利尿剂日间医院模式整合到一个结构化的老年护理路径中,似乎是可行的、安全的,并且与管理高龄急性心力衰竭患者相关。它可能是传统住院治疗的一种有效替代方法。
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引用次数: 0
Une CVDA pas comme les autres 不同的CVDA
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-10-23 DOI: 10.1016/j.ancard.2025.101967
S. DUDAY, T. WAJCHERT
<div><div>Un homme de 46 ans qui a pour seul antécédent une spondylarthrite ankylosante avec sacro-iliite consulte en cardiologie pour une dyspnée d’effort depuis 4 mois. Ce tableau révèle après échographie cardiaque et angioscanner thoracique une dilatation et une dysfonction du ventricule droit (VD) sans embolie pulmonaire. L’ECG met en évidence une onde epsilon et un aspect de bloc de branche droit incomplet (BBD) avec ondes T négatives de V1 à V4. La télémétrie montre des épisodes de tachycardies ventriculaires non soutenus. La coronarographie est normale. Le cathétérisme droit ne montre pas d’hypertension pulmonaire et l’angiographie du VD montre un aspect en pile d’assiettes. L’IRM cardiaque montre des zones dyskinétiques et anévrismales du VD avec des plages de rehaussements tardifs ventriculaires gauche et droite ainsi qu’un thrombus intra-VD. On note également la présence d’une dysfonction systolique du ventricule gauche (FEVG à 35%).</div><div>Alors que le diagnostic de cardiomyopathie arythmogène du ventricule droit (CVDA) est en train d’être posé devant 3 critères majeurs et 2 mineurs de la Task-Force<span><span><sup>1</sup></span></span>, on note cependant plusieurs atypies dans le dossier. Premièrement, les troubles du rythme ventriculaire s’associent à des troubles de conductions (BAV 1 et BAV2 Mobitz 2 à la télémétrie). Deuxièmement, en IRM la paroi du VD n’est pas amincie et il existe un important œdème septal. Enfin, il n’existe pas d’antécédents familiaux de cardiomyopathies.</div><div>L’ensemble de ces éléments peuvent alors faire suspecter une sarcoïdose cardiaque.</div><div>Le bilan extracardiaque de la sarcoïdose met uniquement en évidence des épaississements de septa interlobulaires, et un antécédent de sacro-iliite qui bien que décrite dans les sarcoïdoses, n’est pas typique<span><span><sup>2</sup></span></span>. En revanche le PET-TDM met en évidence un hypermétabolisme diffus du VD, du septum et de la paroi inférieure, sans autre hypermétabolisme associé. La biopsie endomyocardique confirme la présence de granulomes épithélioïdes gigantocellulaires sans nécrose caséeuse, et donc le diagnostic de sarcoïdose. Le patient a été par la suite implanté d’un défibrillateur implantable et traité par méthotrexate et corticothérapie.</div><div>La CVDA et la sarcoïdose cardiaque sont des pathologies pouvant être difficiles à distinguer car elles peuvent remplir toutes les deux les critères diagnostiques de la Task-Force. Toutefois comparée à la CVDA, la sarcoïdose cardiaque se révèle à un âge plus tardif (45 ans d’âge médian au diagnostic 29 ans), il n’existe pas d’histoire familiale, et est plus souvent associée à des troubles de conductions, à une dysfonction VG et à un rehaussement tardif en IRM dans le septum, comme chez notre patient<span><span><sup>3</sup></span></span>. De plus, notre patient ne présentait pas d’atteinte extracardiaque évocatrice de sarcoïdose, renforçant la difficulté du diagnostic.</div><div>S’il faut effe
一名46岁的男性,有强直性脊柱炎和骶骨炎的唯一病史,在过去的4个月里,他一直在心脏病科寻求压力呼吸困难的治疗。这张图显示,在心脏超声和胸部血管扫描后,右心室(VD)扩张和功能障碍,但没有肺栓塞。心电图显示epsilon波和不完全直支阻滞(BBD)方面,T波从V1到V4为负。遥测显示无持续性心动过速发作。冠状动脉造影是正常的。直肠导管不显示肺动脉高压,VD血管造影显示盘状外观。心脏核磁共振显示VD的运动障碍和动脉瘤区域,伴有左、右心室晚期升高和VD内血栓形成。左心室也有收缩压功能障碍(35% FEVG)。虽然右心室心律失常性心肌病(CVDA)的诊断是根据3个主要标准和2个次要标准1提出的,但在档案中注意到一些非典型。首先,心室节律障碍与传导障碍有关(BAV 1和BAV2 Mobitz 2遥测)。其次,在MRI中,VD壁没有变薄,有明显的隔水肿。最后,没有家族心肌病病史。所有这些因素都可能导致心脏结节病的怀疑。心脏外结节病检查只显示7个小叶间增厚,并有骶髂炎史,虽然在结节病中描述,但不是典型的2。另一方面,PET-TDM显示VD、隔膜和下壁的弥漫性过度代谢,没有其他相关的过度代谢。心内膜活检确认存在无干酪性坏死的巨细胞上皮样肉芽肿,因此诊断为结节病。随后,患者接受了可植入的除颤器,并接受了甲氨蝶呤和糖皮质激素治疗。CVD和心脏结节病是难以区分的疾病,因为它们都符合特别工作组的诊断标准。但是CVDA相比,发现心脏结节病的年龄较晚(29岁,中位年龄在45岁诊断),没有家庭的历史,并且是最常伴conductions失调,导致肝功能障碍VG和一个延迟增强mri在鼻中隔,如同我们patient3身上。此外,我们的病人没有引起结节病的心外病变,这增加了诊断的难度。虽然CDVA的诊断确实必须根据工作组的不同类别的标准进行,但在非典型病例前进行显影检查的可能性1,在非典型病例中,对风险的评估不同,可以提出特定的治疗(免疫抑制剂)。图1 - 4
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引用次数: 0
Safety of exercise training for cardiac patients : results of a French multicenter COCARE study (COmplications in CArdiac REhabilitation) 运动训练对心脏病患者的安全性:一项法国多中心COCARE研究结果(心脏康复并发症)
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-09-22 DOI: 10.1016/j.ancard.2025.101940
Bruno Pavy , Marie-Christine Iliou , Mohamed Ghannem , Dany Marcadet , Warner Mampuya

Background

Cardiac rehabilitation is widely recognized as beneficial for patients with coronary artery disease, post-cardiac surgery, and heart failure, although it is underutilized. However, the benefit-risk balance must be updated to reflect the evolving characteristics of treated populations.

Objective

To evaluate the safety of supervised exercise training in a large sample of French cardiac rehabilitation patients, and to assess the utility of the modified Risk of Activity Related Events (RARE) score in identifying low-risk individuals.

Methods

This multicenter observational study included 6,793 patients from 32 centers surveyed between 2023 and 2025. Each center collected data over four consecutive months, including patient characteristics and events that interrupted programs, required transfer to acute care, or resulted in rehabilitation cessation. The modified RARE score was applied to identify a low-risk subgroup. Events were considered activity-related if they occurred during or within one hour of a training session.

Results

A total of 964 events (14.2%) were reported, of which 154 (2.3%) were activity-related. Two cardiac arrests occurred—one fatal—representing 0.98 cardiac arrests and 0.49 deaths per 100,000 patient-hours of training. A modified RARE score < 4 defined a low-risk group with an area under the ROC curve of 0.67 and an excellent negative predictive value (0.99). However, specificity was limited (0.32), reflecting the low incidence of events even in high-risk patients.

Conclusion

The COCARE study confirms the low risk of supervised exercise in phase II cardiac rehabilitation. The modified RARE score may be useful in identifying patients who could safely benefit from alternative, less monitored formats such as telerehabilitation.
背景:心脏康复被广泛认为对冠状动脉疾病、心脏手术后和心力衰竭患者有益,尽管它尚未得到充分利用。然而,必须更新利益-风险平衡,以反映治疗人群不断变化的特征。目的评估法国心脏康复患者大样本中监督运动训练的安全性,并评估改进的活动相关事件风险(RARE)评分在识别低风险个体中的效用。该多中心观察性研究纳入了来自32个中心的6793例患者,调查时间为2023年至2025年。每个中心收集了连续四个月的数据,包括患者的特征和中断项目的事件,需要转到急性护理,或导致康复停止。采用改良的RARE评分来确定低风险亚组。如果事件发生在训练期间或一小时内,则被认为与活动有关。结果共报告964例(14.2%),其中运动相关154例(2.3%)。发生了两次心脏骤停,其中一次是致命的,这意味着每10万患者小时的训练中有0.98次心脏骤停和0.49次死亡。修改后的RARE评分<; 4定义为低风险组,ROC曲线下面积为0.67,极好的阴性预测值(0.99)。然而,特异性有限(0.32),反映了即使在高危患者中事件的发生率也很低。结论COCARE研究证实了监督运动在二期心脏康复中的低风险。修改后的RARE评分可能有助于确定哪些患者可以安全地受益于其他较少监测的形式,如远程康复。
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引用次数: 0
Fibrose endomyocardique biventriculaire mimant une endocardite infectieuse 模拟感染性心内膜炎的双心室肌内纤维化
IF 0.3 Q4 Medicine Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.ancard.2025.101931
Falah Aboukhoudir , Karim Moussa , Sami Rahmani , Safia Chebrek , Sofiene Rekik , Alexandra Dernys
Endomyocardial fibrosis is a rare form of restrictive cardiomyopathy consequent to endocardial damage mediated by hypereosinophilia. It is characterized by fibrous deposits in the ventricular endocardium to a lesser extent, in the myocardium. We report the case of a 75-year-old man having chronic myeloid leukemia in blastic phase, in whom we diagnosed an endomyocardial fibrosis mimicking infective endocarditis. We describe diagnostic modalities and clinical evolution.
心内膜纤维化是一种罕见的限制性心肌病,由嗜酸性粒细胞增多介导的心内膜损伤引起。它的特点是纤维沉积在心室心内膜,在心肌中较少。我们报告的情况下,75岁的男子慢性髓性白血病在母细胞期,我们在其中诊断为心肌内膜纤维化模拟感染性心内膜炎。我们描述了诊断方式和临床演变。
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引用次数: 0
期刊
Annales de cardiologie et d'angeiologie
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